Office of Student Financial Aid Verification Worksheet ...

Office of Student Financial Aid Verification Worksheet 2019-2020

Your 2019-?2020 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct information, we will compare your FAFSA with the information on this institutional verification document and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You and a parent whose information was reported on the FAFSA must complete and sign this institutional verification document, attach any required documents, and submit the form and other required documents to us. We may ask for additional information. If you have questions about verification, contact us as soon as possible so that your financial aid award will not be delayed.

_____________________________________________________________

Student Last Name

Student First Name

MI

XXX_______________________

Banner ID Last 6 digits only

Email Address

_____________________________________________________________________________________________________

Permanent Address (include apt #)

City

State

Zip Code

_______________________________

Home Telephone Number (include area code)

_______________________________

Cell Number (include area code)

What you should do: 1. Complete all applicable sections and sign this worksheet (you and at least one parent, if dependent). 2. Your financial aid administrator will compare information on these documents and make corrections if necessary. If there are

differences between your FAFSA information and your financial documents, the Office of Student Financial Aid will send corrections electronically to have your information reprocessed.

STEP 1: Please check the appropriate box and include only the information for the checked box. List the names of all family members who reside in the household. If additional space is needed, please add additional sheet(s)

Dependent Students (List yourself first under "Self") Independent Students (List yourself first.)

Include yourself, your parent(s) including step-parent, parents' dependent children, and other people living in the household, if your parent(s) will provide more than half of their support from July 1, 2019 through June 30, 2020.

Include yourself, your spouse (if married), your children and any other individuals that you will provide more than half of their support from July 1, 2019 through June 30, 2020.

Write in the name of the college for any family member (excluding your parent(s) who will be attending college in a degree program at least half-time between July 1, 2019 and June 30, 2020.

Write in the name of the college for any family member who will be attending college in a degree program at least half-time between July 1, 2019 and June 30, 2020.

Full Name

Age

Relationship

College Attending for 2019-2020 Date of Birth

Self

NC A&T State University

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VWKST 2019-2020

Name_____________________________________________ XXX_______________________________

Banner ID Last 6 digits only

STEP 2:

Tax Forms and Income Information

You are encouraged to use the IRS Data Retrieval Tool to transfer information to your FAFSA. If you do not use the IRS Data Retrieval, you MUST submit a 2017 Federal tax transcript from the IRS by visiting or calling 1-800-908-9946.

Instructions: Please check the appropriate box. Copies of tax returns (1040, 1040A & 1040EZ) are not acceptable documentation for verification purposes. (MUST BE A TAX RETURN TRANSCRIPT FROM IRS)

To Be Completed by STUDENT (Dependent/Independent): (Please check the appropriate box)

I filed a 2017 Federal Income Tax Return and used the IRS Data Retrieval or I am attaching a copy of my 2017 IRS Tax Return Transcript. My spouse and I filed a separate 2017 Federal Income Tax Return. (A copy of the spouse 2017 IRS Tax Return Transcript must be submitted) Have you filed an amended tax return for 2017? If yes, I am attaching a copy of the tax return transcript and signed 1040X. I will not file and am not required to file a 2017 Federal Income Tax Return. (Provide a copy of IRS Non-Tax Filing Form

Independent Students Only)

I was employed in 2017 and not required to file a Federal tax return. (SUBMIT all 2017 W2's if earned income from work and

provide a copy of IRS Non-Tax Filing Form. Independent Students must provide IRS Non-Tax Filing Form)

To Be Completed By PARENT(S): (Please check the appropriate box)

I filed a 2017 Federal Income Tax Return and used the IRS Data Retrieval or I am attaching a copy of my/our 2017 IRS Tax Return Transcript. My spouse and I filed a separate 2017 Federal Income Tax Return. (A copy of the spouse 2017 IRS Tax Return Transcript must be submitted) Have you filed an amended tax return for 2017? If yes, I am attaching a copy of the tax return transcript and signed 1040X. I/We will not file and am not required to file a 2017 Federal Income Tax Return. (Provide a copy of IRS Non-Tax Filing Form) I/We were employed in 2017 and not required to file a Federal tax return. (SUBMIT all 2017 W2's if earned income from work

and provide a copy of IRS, Non-Tax Filer Form)

For Non-Tax Filer (Parent(s) Only) If your parents did not file a 2017 tax return please submit a copy of their 2017 Non-Filer Letter

from the IRS.

For Non-Tax Filer (Independent Student/Spouse Only) If you and your spouse did not file a 2017 tax return please submit a copy

of you and your spouse 2017 Non-Filer Letter from the IRS.

Instructions for obtaining an IRS Verification of Non-Filing Letter:

All non-tax filers are required to provide an IRS Verification of Non-Filing Letter dated on or after October 1, 2018 that indicates that a 2017 IRS income tax return was not filed with the IRS. After receiving the Verification of Non-Filing Letter from the IRS, include the student's Banner ID, then submit to the Student Financial Aid Office.

? Paper Request Form- IRS Form 4506-T- complete lines 1-4, check box 7, enter 12/31/2017 for box 9, check signatory attestation box, sign, date, and submit to the IRS as instructed. Mail or fax to your respective IRS location depending upon your state of residence as shown on page 2 of the 4506-T form.

? Online Request - Go to transcript, and then choose either "Get Transcript Online" or "Get Transcript by Mail." Get transcript online will give you instant delivery via PDF, whereas get transcript by mail you will receive a copy within 5-10 business days. Make sure to request a 2017 Verification of NonFiling Letter.

? Telephone Request - 1-800-908-9946, after following prompts, select option 2 to request an IRS Verification of Non-Filing Letter and then enter "2017."

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VWKST 2019-2020

Name_____________________________________________ XXX_______________________________

Banner ID Last 6 digits only

STEP 3:

Student and Parent's 2017 Untaxed Income

Independent Student: Please indicate below any of the following that apply to you (and your spouse) for the 2017 tax year. Dependent Student: Please indicate below any of the following that apply to you and your parent(s) for the 2017 tax year.

If left blank, the value is assumed to be "0" for processing.

Name of Employer or Sources of Untaxed Income

Student/Spouse Parent

$

$

Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings), including,

but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S. Do not

include amounts reported in code DD (employer contributions toward employee health benefits).

$

$

IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form

1040--line 28 + line 32 or 1040A--line 17.

$

$

Child support received for any of your parents' children. (yearly amount) Do not include foster care or adoption

payments.

Tax exempt interest income from IRS Form 1040 - line 8b or 1040A - line 8b.

$

$

$

$

Untaxed portions of IRA distributions from IRS Form 1040 - lines (15a minus 15b) or 1040A - lines (11a minus 11b).

Exclude rollovers. If negative, enter a zero here.

$

$

Untaxed portions of pensions from IRS Form 1040 - lines (16a minus 16b) or 1040A - lines (12a minus 12b).

Exclude rollovers. If negative, enter a zero here.

$

$

Housing, food and other living allowances paid to members of the military, clergy and others (including cash

payments and cash value of benefits). Do not include the value of on-base military housing or the value of a basic

military allowance for housing. (yearly amount)

$

$

Veterans' non-education benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation

(DIC) and/or VA Educational Work-Study allowances. (yearly amount)

$

$

Other untaxed income not reported in items 45a through 45h, such as workers' compensation, disability, etc. Also

include the untaxed portions of health savings accounts from IRS Form 1040--line 25. Do not include extended

foster care benefits, student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social

Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military

housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria

plans), foreign income exclusion or credit for federal tax on special fuels.

Earnings from work under a cooperative education program offered by a college. (yearly amount)

$

$

$

$

Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form (yearly amount). Combat

pay or special combat pay. Only enter the amount that was taxable and included in your parents' adjusted gross

income. Do not enter untaxed combat pay.

$

$

Education credits (American Opportunity, Hope or Lifetime Learning tax credits) from IRS Form 1040--line 50 or

1040A--line 33.

$

$

Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment.

$

$

Taxable student grants and scholarship aid reported to IRS in you and/or your parents adjusted gross income.

Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and

scholarship, portions of fellowships and assistantships.

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VWKST 2019/2020

Name_____________________________________________ XXX_______________________________

Banner ID Last 6 digits only

(Please Check All Applicable Boxes Below)

STEP 4: Child Support Paid

? Child Support - Did you, one or both of your parents listed in the household on Step 1 pay child support in 2017?

Yes No (If yes, complete the section below)

Name of Person Who Paid Child Support

Name of Person to Whom Child Support

Was Paid

Name of Child for Whom Support Was Paid

Date of Birth for Whom Child

Support Was Paid

Yearly Amount of Child Support Paid

in 2017 $

$

$ $

STEP 5: Required Signatures Certification

By signing below, each person certifies that all the information reported on this form is complete and correct. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.

Please provide a hand-written signature (not a computer-generated signature)

Student Signature__________________________________ Date________________________

Parent Signature___________________________________ Date____________________________ ________________________

(For dependent students)

Relationship to Student

Mail or Fax completed form to:

North Carolina Agricultural and Technical State University Office of Student Financial Aid 1601 E. Market Street, Room 100

Greensboro, North Carolina 27411 Telephone #: 336-334-7973 Fax #: 336-334-7954

North Carolina Agricultural and Technical State University does not discriminate against employees, students, or applicants based on age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law.

VWKST 2019-2020

UPDATED: 10/24/18

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